For those unfamiliar with this controversy, ABMS board certification of a US physicians was once a completely voluntary lifetime accolade physicians could elect to hold after they completed their residency. They paid to take a test created by a self-appointed "board" of academic physicians in their specialty - analogous to the legal bar examination - that "certified" they had a fund of knowledge acceptable to practice their trade. Physicians used this "board certification" as a marketing accolade with their peers to garner referrals from colleagues.
Prior to 1990, ABMS board certification was never required to practice medicine in any US state or territory. Rather, it was the responsibility of the accredited residency program to train doctors and document they had sufficient experience to enter the workforce as that specialist safely. State licensing agencies verified that training and stipulated that physicians earn "Continuing Medical Education" credits to remain current in their field to maintain their state licensure in good standing.
In the 1960's, seeing the financial struggles of older boards formed 30 years before that created the lifetime board certification accolade, the American Board of Family Medicine, a new ABMS member board, was created with a new financial model that proved to be very lucrative: time-limited certification. The ABFM would soon be rolling in cash, earning tens of millions of certification and re-certification fees annually. Not surprisingly, it was not long before all 24 ABMS member boards shifted their certification models to implement time-limited certification by 1990, arguing that doctors had an obligation to keep up in their field (and pay the boards recurrent fees to do so). By 2015, the physician board certification and recertification industry mushroom into a $5.7 billion a year bonanza for the academic elite and their industry colleagues with publishing priority in influential specialty medical journals while not disclosing their conflicts of interest.
The pushback began in 2012 when one physician became frustrated with the arduous and needless re-certification process. After even more new requirements to time-limited certification were added in 2014, a full-blown civil war in medicine between the bureaucratic elite and working physicians began. It was December 2014 when the full extent of the controversy became apparent: "medical professionalism" defined by luxury condominiums complete with their chauffeur-driven Mercedes S-class town cars, spousal travel fees, high salaries, and undisclosed conflicts of the leadership of the member boards.
Never once in the history of time-limited certification were the potential harms of time-limited certification to working physicians considered or acknowledged.
Caught with their hands in working physicians' financial cookie jar, the ABIM issued an unprecedented mea culpa message in February 2015 to its physician membership, but instead of coming clean, the cover-up and tap dancing began in an attempt to preserve the money flow.
Recaps of the revelations and cover-up/pivoting of the process are included here:
2015: The Maintenance of Certification Controversy 2105: The Year in Review
2016: The ABMS/ABIM Controversy 2016: Year in Review
2017: The ABMS/ABIM MOC Controversy 2017: Year in Review
The 2018 summary of events are recapped below:
* * *
12 Jan 2018: Practicing Physicians of America (PPA) sponsors a national survey (questions asked here) of physician attitudes about maintenance of certification, including evaluating potential harms to physicians caused by the process.
27 Jan 2018: Psychology of MOC and the Gaslighting of America's Physicians discussed.
2 February 2018: The ABMS tries to quell physician unrest and forms a 'Vision Initiative' with medical specialty societies and state medical societies (among others) concerning MOC.
8 February 2018: The ABMS Vision Initiative Committee is announced and is laced with numerous non-physicians with many conflicts of interest.
15 Feb 2018: The self-selected ABMS Vision Initiative Committee launches their own survey of physician attitudes toward Maintenance of Certification but steers clear of assessing negative consequences of MOC on physicians.
25 Mar 2018: ABMS/ACP announce partnerships with medical specialty societies to keep the money flowing
6 April 2018: ABIM publishes its "how-to" video on the Knowledge Check-in program revealing its mechanics.
23 May 2018: After ABIM publishes its tax forms late, PPA announces GoFundMe crowdfunding effort effort to raise funds for a pre-litigation investigation into the ABIM and the ABIM Foundation's activities.
11 Jun 2018: Results of the PPA survey on MOC announced at the AMA House of Delegates meeting in Chicago.
28 June 2018: A critical review of the ABIM Knowledge Check-in option for Maintenance of Certification (video) is published questioning a physician's right to privacy.
2 Aug 2018: The Federation of State Licensing Boards tries to legislate away their liability.
26 Aug 2018: The ABMS releases the results of their survey on MOC and the results are similar to the survey sponsored by Practicing Physicians of America.
6 Sep 2018: A video reviewing the main PPA survey results on MOC from 7007 physicians is published.
7 Sep 2018: PPA's GoFundMe effort reaches its goal of $150,000.
14 Sep 2018: DOJ issues opinion on MOC, calling the program "anti-competitive."
25 Sep 2018: The ABMS and American Board of Urology offer their spin on the DOJ letter concerning MOC®.
1 Dec 2018: The ABIM Knowledge Check-In program crashes and hundreds of physicians are left in limbo.
6 December 2018: Four physicians sue the ABIM in a class action lawsuit representing over 100,000 physicians claiming anti-trust violations, among others.
10 December 2018: ABIM issues a statement concerning the suit on its blog promising that "the organization will vigorously defend itself, recognizing that doing so will consume resources far better dedicated to continuous improvement of its programs."
21 December 2018: The far-reaching implications of the antitrust suit reach across the pond.
* * *
It's been quite a ride. Here's to a productive New Year in 2019!